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Common Conditions

Allergic Rhinitis/Rhinosinusitis:

Microscopic inflammation of the nasal and sinus tissues is the cause of the symptoms commonly referred to as nasal allergy, aka “hay fever”. Nasal congestion, drainage, sneezing, itching, pressure are common complaints. The true cause of allergy is the formation of allergic antibodies by the immune system called IgE against pollens, dust, pet dander, and molds. Allergy testing can be used to discover if someone is allergic and what triggers they have. This can aid in avoidance and recommended treatment choices.

Immune Deficiency (aka Immunodeficiency):

If you think of the human immune system like an army, there are soldiers with unique abilities (white blood cells), and different artillery/bullets (antibodies). If you do not have enough soldier types, or they are poorly trained, recurrent infections will be the result. Also, if you lack enough bullets, recurrent infections will be the consequence. If 6 or more antibiotics a year are required for infections such as sinus and chest infections, an evaluation of the immune system may be recommended. This involves lab testing and if needed, vaccine challenges may be performed to access your response.

Skin Allergies, Urticaria (hives), and Eczema:

Skin reactions occur due to external exposures (allergens, chemicals, medications, infections) or from internal conditions (such as liver, thyroid, or autoimmune diseases) that manifest with skin rashes. The goal is to find the cause of the skin condition and exacerbating factors. Testing to search for the cause of the rashes can include allergy skin testing for allergens and foods, chemical Patch testing, blood testing, and even biopsies of affected skin.

Stinging Insect and Drug Allergy:

Allergy to venoms from stinging insects (honey bee, wasp, yellow jackets, and hornets) can be a life-threatening condition. True allergy means that a venom-specific antibody called IgE is present in the body, and exposure can lead to anything from mild to fatal reactions. Testing can be performed to see if a person is at risk for anaphylactic reactions.

Drug reactions are a complex topic as there are numerous types of drug reactions possible. Although some drug reactions are truly an allergy with the presence of drug-specific IgE (called type 1 reactions), many are not and are thus impossible to test with blood or skin tests. Intolerance reactions such as upset stomach or loose stools are not true allergic reactions although avoidance is generally followed to avoid unwanted symptoms. Some drug reactions are due to excessive metabolism or slow metabolism, interaction with other medications, or simply idiopathic. Reactions involving immune complexes that can lead to rashes, fever, and arthritis were historically referred to as serum sickness reactions (type 3), and avoidance is urged but testing not available. Type 2 reactions are often related to anemias, and type 4 are delayed reactions with rashes. Unfortunately, only type 1 (IgE) reactions can be testing for with varying accuracy. History is critical to determine the best way to test and manage these drug reactions.

Food Allergies:

There are many different manifestations of food allergies. Immunologically this occurs when your body reacts to the proteins in the foods. When the reactions occur because of inability to digest the sugar content of the foods, this is considered non- allergic or intolerance. A common example would be lactose intolerance, usually gastrointestinal problems that occur when we are not able to digest lactose, the sugar moiety of milk.
Food allergies can present at any age, from infancy to adulthood. Patients present differently, some with itchy throat/mouth, hives, others with abdominal discomfort, or even vomiting.

Extreme case of allergic reaction to foods is called anaphylaxis, where the reaction(s) can be life-threatening. Signs can include generalized hives, swellings, diarrhea, shortness of breath, wheezing and cardiovascular collapse.
We can help by identifying the offending food allergens. Testing and sometimes food challenges may be necessary. The main treatment of food allergy is of course, avoidance of the foods that trigger your allergies. For the severe case, carrying an epinephrine injectable is a must. And for children, having a specific food allergy plan for daycare, and school must be included.

Eosinophilic Esophagitis:

Eosinophilic esophagitis (EoE) is an allergic inflammatory disease characterized by a large number of white blood cells called eosinophils that cause inflammation in the lining of the esophagus (the tube that connects the mouth and stomach). It is commonly associated in patients with other allergic conditions such as allergic rhinitis (hayfever), asthma and atopic dermatitis (eczema). Common signs and symptoms can vary with age: infants and toddlers may not be growing properly refusing foods, school-age children may be having abdominal pains or vomiting, and others may have difficulty of swallowing or foods stuck in the throat/ esophagus.

We can help by identifying offending food allergens and then provide dietary recommendations accordingly. Studies have also shown that some EoE may be seasonal and affected by environmental allergens and testing to these allergens may be recommended.

Alongside your gastroenterologist, we will recommend treatments including proton pump inhibitor medication and swallowed topical corticosteroids to control the inflammation and to suppress the eosinophils.

Asthma:

Asthma is a common lung disorder which can present with episodes of cough, wheeze, tightness in the chest and shortness of breath. Asthma is caused by inflammation of the lining of the airways in the lungs which leads to limitation of airflows from and to these tubes. Asthma may develop at any age.

Our medical practice is solely dedicated to practice of allergy and asthma, providing you with expertise firstly to determine if you indeed have asthma or not, and then identify and treat the underlying triggers so asthma can be better controlled with hopefully less amount of medications. We can also provide immunotherapy either in injectable or sublingual forms, reducing the sensitivities to airborne allergens contributing to inflammation in asthma, as well as reducing inflammation in the sinus and nasal passages which in turn improve the health of the lower respiratory tracts.
Depending on the severity of your asthma, we will devise individualized asthma treatment plan.